CALIFORNIA TELEHEALTH POLICY COALITIONFINAL LOGOType: Brandon GrotesqueThird round: 10/7/19Dennis Johnson Design

CaliforniaTelehealthPolicy Coalition

CaliforniaTelehealthPolicy Coalition

Telehealth Opportunities for California

OCTOBER 2019

1CALIFORNIA TELEHEALTH POLICY COALITION

Expanding telehealth is an opportunity for California to: Increase Access to Health CareTelehealth can increase access to health care providers, particularly in rural areas. By bringing care closer to patients, or into their homes, telehealth can make life-saving differences for patients who face the barriers of transportation, mobil-ity or cost.

Improve Health Outcomes Research supports the positive impact telehealth can have on health outcomes.

l Veterans Health Administration patients who faced travel burdens reaching specialized HIV treatment centers were able to effectively manage their treat-ment when they could access telehealth services near them.1

l Post-operative bypass surgery patients experienced better general health functioning using remote patient monitoring than those without it.2

l Diabetics offered digital self-management, health education and social networking tools reported lower blood pressure and better health behaviors like healthy eating and physical activity.3

Telehealth brings a pediatric neurologist to the remote community of Redding via video, where primary care provider, Dr. Saini, facilitates appointments for Maurice, who was born with cerebral palsy. Dr. Saini says:

“ If we did not have telemedicine neurology at our facility, I worry about missed appointments,” since Maurice’s specialist is a three-hour drive away. Maurice’s grandmother and caregiver Bobbi says telemedicine is a “blessing” for her family. “’Reece’ is getting the same treatment that he would get if I took him to Sacramento.”

“ Sometimes I’d travel an hour and a half to two hours each way [to see a therapist]. A lot of the time I was stressed about getting there. If I had a ride coming, would it be on time? And the traffic, the expense of it. By the time I got to my therapist, I couldn’t really concentrate on what I needed to be there for.” n Debbie

Today too many patients in California’s health care safety net face long wait times or travel long distances to see providers, especially specialists. The resulting delays in care can have serious con-sequences for their health.

Debbie of Anza, CA utilizes telehealth mental health services at Borrego Health in Riverside County.

1. Ohl, M et al. Impact of Availability of Telehealth Programs on Documented HIV Viral Suppression: A Cluster-Randomized Program Evaluation in the Veterans Health Administration. Open Forum Infect Dis. 2019;6(6). doi: 10.1093/ofid/ofz206.

2. Barnason, S, Zimmerman L, Nieveen J, & Hertzog M. Impact of a telehealth intervention to augment home health care on functional and recovery outcomes of elderly patients undergoing coronary artery bypass grafting. Heart & Lung. 2006 Jul-Aug;35(4):225-233. doi: 10.1016/j.hrtlng.2005.10.003.

3. Carter, EL, Nunlee-Bland G, & Callender C. A Patient-Centric, Provider-Assisted Diabetes Telehealth Self-management Intervention for Urban Minorities. Perspect Health Inf Manag. 2011;8:1b. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3035826/. Accessed October 18, 2019.

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Telehealth Opportunities for California OCTOBER 2019

CALIFORNIA TELEHEALTH POLICY COALITION

Enable Cost-Effective CareTelehealth is cost-effective for both patients and providers: that’s why it is embraced by insurers and providers like Kaiser Permanente and the Veterans Health Administration. Commercial payers alone are estimated to have experi-enced a 56% increase in telehealth utilization from 2016 to 2017.4

Telehealth has been associated with cost-effectiveness in studies ranging from rural live video programs5, to e-consult programs in Medicaid6, to using multiple telehealth modalities to treat people with chronic conditions.7 The Centers for Medicare & Medicaid Services (CMS) has identified many examples of telehealth reducing costs or improving care without affecting cost. For example, a study of 11 nursing homes showed that using telehealth for physician coverage during off hours could reduce hospitalizations and generate an average savings to Medicare of $151,000 per nursing home.8

CMS has detailed opportunities to reduce costs or improve care by implement-ing telehealth into Medicare services, with a focus on: l Rural populationsl Urban populations l Patients with end-stage renal disease l Patients in long-term care facilities l Patients with disabilities l Patients with chronic disease l Patients with mental health disordersl Patients with substance abuse disorders, including opioids9

Deliver Care with High Patient Satisfaction“ People care. That’s the main thing, is these people really care

that I get better and they actually are giving me the help that I need. No, I don’t have money, but I can have the same kind of healthcare as everyone deserves.” n Jill

Studies going back as far as 2010 show that telehealth results in high patient satisfaction, as well as improved outcomes.10

l Ninety percent of geriatric patients using live video telehealth reported liking or preferring telehealth compared to face-to-face care.11

l Obstetric patients who chose telehealth care report higher overall satisfaction compared to patients who chose traditional, in-person care.12

l Veterans Health Administration patients consistently rate satisfaction with telehealth services equivalent to in-person visits for the same type of service.13

A UC Davis study analyzing 18 years of patient data found that telehealth helped patients avoid more than five million miles in travel and $3 million in travel costs.

Bobbi takes her grandson Maurice to telehealth visits in Redding, CA. Maurice was born with cerebral palsy and experiences seizures.

4. Fair Health. FH Healthcare Indicators and FH Medical Price Index 2019: An annual View of Place of Service Trends and Medical Pricing. Published April 2019. 5. Pyne, JM et al. Cost-effectiveness Analysis of a Rural Telemedicine Collaborative Care Intervention for Depression. Arch Gen Psychiatry. 2010 Aug;67(8):812-821. doi:

10.1001/archgenpsychiatry.2010.82.6. Anderson, D et al. Reduced Cost of Specialty Care Using Electronic Consultations for Medicaid Patients. Health Aff. 2018 Dec;37(12):2031-2036. doi: 10.1377/

hlthaff.2018.05124.7. Thomas, CL et al. Effectiveness and cost-effectiveness of a telehealth intervention to support the management of long-term conditions: study protocol for two linked

randomized controlled trials. Trials. 2014 Jan 24;15:36. doi: 10.1186/1745-6215-15-36. 8. Centers for Medicare & Medicaid Services. Information on Medicare Telehealth. https://www.cms.gov/About-CMS/Agency-Information/OMH/Downloads/Informa-

tion-on-Medicare-Telehealth-Report.pdf. Published November 15, 2018.9. Ibid. 10. Kruse, CS et al. Telehealth and Patient Satisfaction: A Systematic Review and Narrative Analysis. BMJ Open. 2017;7(8): e01642. doi: 10.1136/bmjopen-2017-016242. 11. Hantke, N et al., (2019). Patient Satisfaction With Geriatric Psychiatry Services via Video Teleconference. Am J Geriatric Psych. 2019 Aug 24. Pii: S1064-7481(19)30493-2. doi:

10.1016/j.jagp.2019.08.020.12. Pflugeisen, BM, and Mou, J. Patient Satisfaction with Virtual Obstetric Care. Matern Child Health J. 2017 Jul;21(7):1544-1551. doi: 10.1007/s10995-017-2284-1.13. Veazie, S, Bourne D, Peterson K et al. Evidence Brief: Video Telehealth for Primary Care and Mental Health Services. Washington (DC): Department of Veterans Affairs (US);

2019 Feb. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538994/.